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itoring System Certification is <br /> Site Address: 401 W. KETTLEMAN LANE Date of Testing/Service: 02/04/2003 <br /> F. In-Tank Gauging /SIR Equipment ® Check this box if tank gauging is used only for inventory control. <br /> ❑ Check this box if no tank gauging or SIR equipment is installed. <br /> This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. <br /> Complete the following checklist: <br /> ❑Yes ❑No- Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> ®Yes ❑No- Were all tank gauging probes visually inspected for damage and residue buildup? <br /> Q Yes No- Was accuracy of system product level readings tested? <br /> a Yes ®No° Was accuracy of system water level readings tested? <br /> M Yes ❑No• Were all probes reinstalled properly? <br /> 0 Yes ❑No• Were all items on the equipment manufacturers'maintenance checklist completed? <br /> "In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> G. Line Leak Detectors (LLD) : ❑ Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> For equipment start-up or annual equipment certification,was a leak simulated to verify LLD performance? <br /> ®Yes ❑No. ❑N/A (Check all that apply)Simulated leak rate: [fl 3 g.p.h❑0.1 g.p.h 00.2 g.p.h <br /> FX-1 Yes E]No- Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> FX-1 Yes ❑No- Was the testing apparatus properly calibrated? <br /> ®Yes ❑No- ❑N/A For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> ❑Yes ❑No. ®N/A For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> ®Yes ❑No- ®N/A For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br /> ❑Yes ❑No- Q N/A For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br /> ❑Yes ❑No" Q N/A For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> L_I Yes ❑No- Were all items on the equipment manufacturers'maintenance checklist completed? <br /> *In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> H. Comments: <br /> page 3 of 3 <br />